Best practices for 340B claims billing

Last update: June 3, 2021

The 340B program is administered by the Health Resources & Services Administration (HRSA).

Pharmaceutical companies participating in Medicaid programs are required to adhere to Section 340B of the Public Health Service Act. It allows them to sell outpatient drugs at discounted prices to eligible covered entities, making them affordable for many uninsured and low-income patients.

Follow these guidelines when filing billing claims:

Pharmacy benefits

• NCPDP Data ELEMENT 409-D9: Ingredient Cost Submitted = 340B Acquisition Cost with the associated value 08 in NCPDP field 423-DN: Cost Basis
• NCPDP Data Element 420-DK: Submission Clarification Code = 20

Medical benefits

• Modifier: UD
• Description: Medicaid level of care 13, as defined by each state

For more information, go to 340B Drug Pricing Program | Official website of the U.S. Health Resources & Services Administration (hrsa.gov).